Ball, Harriet
(2021)
The role of psychological flexibility in birth experience for first-time mothers: a mixed methods study.
DClinPsy thesis, University of Nottingham.
Abstract
Background: Childbirth is a momentous event for a woman where they can feel empowered and transformed. Negative experiences of birth are linked to development of perinatal mental health difficulties including postnatal depression and birth trauma (Ayers et al., 2016; Bell & Anderson, 2016). Birth can be experienced as negative when birth expectations are not met (Goodman et al., 2004; Hauck et al., 2007). Psychological Flexibility (PF) is a concept adopted within the Acceptance and Commitment Therapy (ACT) model (Hayes et al., 1999). PF could illustrate how a woman adapts to situational demands of birth, shifts perspective or expectations and balances competing wishes and values that encompass expectations of birth. This study aimed to 1) explore the relationships between PF, birth satisfaction and birth expectations, 2) explore whether women report PF-related skills as playing a role in sense-making of birth, and 3) explore what aspects women describe as helping and/or hindering sense-making of birth.
Methods: A sequential explanatory design following two phase, mixed methods design was used. Phase One involved collection of data pre- and post-birth (N = 68) to explore whether level of PF moderated appraisal of birth. Phase Two involved semi-structured interviews (N = 11) exploring what aspects played a role in sense-making of birth to further explain Phase One findings. Phase One analysis involved nonparametric correlations, independent samples t-test and a Content Analysis. Phase Two involved a deductive-inductive Thematic Analysis (TA).
Results: For Phase One, nonparametric correlations indicated no significant relationship between PF and Birth Satisfaction or Birth Expectations. A significant negative relationship was found between Birth Satisfaction and Birth Expectations (p < .001). An independent samples t-test indicated a significant relationship between Birth Satisfaction and Birth Type (p < .001). A Content Analysis indicated the most common reasons for unmet birth expectations: intervention needed, length of labour and medical complications.
For Phase Two, the deductive TA considered two themes: Psychological Flexibility and Psychological Rigidity. The theme Psychological Flexibility captured aspects that resembled the six core therapeutic processes of PF (Hayes et al., 2006). The theme Psychological Rigidity captured aspects resembling the six core pathological processes of psychological rigidity (Hayes et al., 2006).
The inductive TA constructed five themes: Support & Care, Choice/Control, Personal Processes, Preparedness and Birth Processes. The first theme Support & Care involved four subthemes: communication, influence of others, healthcare and talking. The third theme Personal Processes involved three subthemes: mindset, attributes and internal processes. The fifth theme Birth Processes involved two subthemes: labour and medical challenges.
Discussion: Current conceptualisations of birth satisfaction are potentially not capturing important nuances. Discrepancies between Phase One rand Phase Two could be explained by interviews enabling reflective capacity. PF appears to play an important role in sense-making of birth but sense-making also involves other complex processes. Findings could suggest changes to maternity care e.g., antenatal education and providing opportunities for sense-making. Future research could explore the function of acceptance in birth satisfaction and its relationship with perinatal mental health.
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